Study of Stool Color Chart
Stool Colour Chart – A Qualitative Study Page 8
Cost-Effectiveness of Screening
A cost-effectiveness modelling study on screening with SCC alone in United States showed potential savings of
USD$9 million, three fewer associated deaths and 11 fewer liver transplants. [35] This study probably far
underestimates the potential savings of a SCC programme as it can help with earlier diagnosis of other
neonatal liver diseases e.g. neonatal hepatitis, Cystic Fibrosis, paucity of biliary ducts in Alagille Syndrome, or
Alpha-1 Antitrypsin Deficiency.
Furthermore, Schrieber et al. in Canada have found a passive SCC reporting system; much like the one
implemented in Japan and Taiwan, was most cost effective and also resulted in fewer liver transplants and
more HPE being performed. Despite, having a SCC return rate of 55-63 percent, the use of more intensive
follow-up systems, e.g. follow-up phone calls, posted reminder cards, only led to nominal increases in return
rates and exponential increase in costs. [36]
This study plans to utilise established WCTO frameworks with the LMC as primary contact for passive screening
and education. There will be agreed contact where the SCC is reviewed with health professionals so as to
capture any families that may not have utilised their cards independently in a passive home-based
programme. The cost in time and financial terms for families and LMC/WCP is estimated by the Investigators
as minimal as it is incorporated into already scheduled routine interactions with the families.
The main cost would be instituting and distributing the SCC itself, although there may be increased laboratory
costs as the positive SCC screening infants will be required to undergo blood tests as well as possible review by
medical professionals. The cost of unnecessary investigations and assessments due to false positives is
reduced by an expected high SCC specificity. [31] Nonetheless, with any report of acholic coloured stools, the
current standard of care should be for further investigations and clinical assessment by medical professionals.
The SCC raises awareness of acholic stools and the study protocol is aligned with local best practice guidelines.
[37]
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